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I send you a case just now, though I believe you will
hardly be disposed to give me any thanks for doing so. My plan was
that, if the Lady who is the subject of it had been able, she should
about this time, have taken a journey to Edinburgh, and consulted you
in person; and we proposed to have been with you together, for I find
that I shall soon be obliged, against my will, to have the pleasure of
seeing you, having been called to be a Witness in a criminal trial which
is soon to come on. –– I have said that you will not thank me for taking
your opinion in this case, for indeed it is a most unfavourable one, and
neither our patients friends nor I expect that you will do much for us;
though I need not say that we will be very happy if we find ourselves
mistaken. –– The Patients own anxiety and complaining disposition
made the measure of consulting you necessary.

Mrs Blackstock, now aged about 54 of a very thin habit, and
a constitution which has been always delicate and sickly, began,
about 18 months ago, to complain of pains in her legs, which, in a
short time, became so severe as to deprive her very much of ease through
the day, and of sleep in the night. To these were joined several other
circumstances which were obvious marks of a very cachetic state.
Upon different parts of her head, there were, under the skin, flattened, glan¬
dular tumors, about the size of peas and small beans. –– There was more
or less of a foulness of her face, which had been of many years standing.
Upon the legs themselves several slight eruptions appeared; but, what
was more particular, on feeling upon the shins, which were a little pain¬
ful to the touch, there was an evident inequality for the space of three
or four inches, which could be referred only to the bone or periosteum
In short, It might have been conjectured that the symptoms depended
upon a venereal taint; but of this there could not be the smallest sus¬
picion. –– It was about the beginning of July last that I first saw her,
after she had been using for more than two months the Decoction of the
woods with a small proposition of Tartar emetic; and I think opiates
occasionally.

Judging that the case required more than our ordinary rheumatic

Accordingly, in the space of between three and four weeks Mrs B. used
between twenty and twenty five grains of well levegated Calomel, in a
very slow manner, but so as to produce a sensible and pretty equal
effect in the mouth. This she bore without any inconvenience whatever; and
the effect of it, in relieving the pains of her legs, was soon experienced.
By the time that the half of the course was over, and for ten or twelve
days after it was finished, they were so much relieved, or rather she
complained of them so little, that, when she had used the quantity which
I have mentioned, I could not desire her to take any more; though
I could have wished her to have done so, as the quantity taken in
all was not inconsiderable. –– After an interval of five or six weeks
the pains returned, and seemed again to be pretty severe. During the
autumn and winter however (whilst I saw her but seldom) though I be¬
lieve she was often complaining, yet I do not suppose the pains ever
continued for any length of time so severe as they were before she
used the Mercury; –– for, though I had recommended mustard seed, she
never thought of taking it till within these two or three {illeg} months,
and when she did begin to use it, other symptoms appeared requiring
other remedies. –– The glandular tumors on her head, foulness of her face,
and inequality of her shins have continued all along, pretty much the
same. –– By the bye, I made a second attempt with mercury when her
pains returned, using a kind of Plummers Pill, prepared with quicksilver
instead of Calomel; - but she did not agree with it, & took not more than 6 pills.

Now, to come to the last and present part of her case, - it is more
than two months since her feet and ancles began to grow odematous,
and it was soon found likewise that her thighs and belly were swelled.
These symptoms were immediately accompanied with a considerable scarcity
of urine, and the little that she voided became exceedingly foul and turbid.
In short the case was evidently growing dropsical, and, in that view, now

When the dropsical symptoms shewed themselves to such a de¬
gree as to require particular remedies I prescribed what I first learnt
the use of at St Thomas's hospital in London, and confirmed,
remarkably, as I thought, in two unfavourable cases here
at {illeg}↑home it↑ was a decoction of the Bark with regenerated
[Start of margin text]Tartar.[End of margin text] {illeg} about three weeks Mrs B. consumed, every two
days, a pound of the common decoction of bark with half
an ounce of the regen: Tartar dissolved in it. – Now, Sir, I hope you
will not suspect me of exaggerating the effects of my prescriptions,
but I must say that this medicine gave as visible a check to the
present symptoms as Mercury had done in the former instance. –
It {illeg} produced any observable (↑a considerable↑) alteration in the colour or consist
quantity of her urine, and, by the time that she had used it ten days
or a fortnight, her feet and ancles, which were turgid before, were
almost free of any degree of œdema, as likewise her thighs. The
Measure of the abdomen was lessened about two inches, and seemed to
be still gradually lessening, but in the third week (i.e. of using the De¬
coction) it seemed to be at a stand; – and, as she tired of taking
the medecine, saying that her stomach refused it, I was obliged to
desist. – Very soon the swelling every where encreased to its former
degree, and is now such as I have above described it.

Since we desisted from this last course I have made an attempt
with Squills, but she cannot bear them. One grain of them dried, purges
her, and two grains made her vomit. – I have tried twenty drops of

Till within these two or three days Mrs B. notwithstanding her weak¬
ness, has been always going abroad now and then, on horseback, or in
a carriage, & we still propose a journey, which will be to you, if she
shall appear capable to understand it.

Before the Dropsical symptoms appeared I proposed that she should
have gone to the country to drink goats whey next month.

Mrs B. was married young, has been long a Widow and never
bore children. –– By Saturday nights post, wh leaves you on friday
night, I shall expect the pleasure to hear from you, & in the mean time am
with very sincere regard

To Doctor Cullen
Physician
Edinburgh

✍
Dr Gilchrist q.
Mrs Blackstock
May 22d 1776